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Trends in the Use of Telemedicine during the Covid-19 pandemic

Though several things have changed the way the world works, few have had as much an impact as the coronavirus. This respiratory infection has been announced by the WHO as a pandemic, with governments worldwide taking different steps to curb its spread. The most crucial factor in reducing the spread of covid-19 has been maintaining a ‘’social gap’’ or social distancing to negate person-to-person virus transmission. This has seen travel restrictions enforced, people encouraged to stay indoors or work from home, schools closed, and the use of PPEs like masks.

The measures undertaken to reduce the spread of Covid-19 have undoubtedly had a significant impact on the daily lives of people and the running of businesses. Even so, few sectors have seen as high a growth as the telehealth market. This comprises technologies that allow healthcare workers to hold meetings, consult and exchange information remotely with their peers or patients.

Telemedicine is one of the popular technologies under telehealth. This is the remote provision of medical services using technology that enables the exchange of information to facilitate the prevention, identification, and management of a disease. Some of the technologies used in telemedicine include remote patient monitoring and videoconferencing.

Before the Covid-19 pandemic in the U.S, less than 10% of patients used telehealth, and only about 18% of health care providers offered their services via telehealth or virtual care. The number of patients opting for telehealth services leaped to 76% of patients in the U.S during the Coronavirus disease pandemic.

Some healthcare providers assume that telehealth is a fad that will end as the coronavirus infection numbers start dwindling and would thus be a wasted investment. According to a study, 83% of patients plan to continue with the rapid implementation of telemedicine platforms long after the current pandemic. Moreover, the global market size for telehealth is expected to reach an estimated $175.7 billion from the 45.5 billion in 2019 when the pandemic started. These statistics prove that expansion of telehealth services is imminent.

The increased use of telemedicine does not mean that in person services no longer have a part in the healthcare system. According to a qualitative study included in JAMA Network Open, an increase in telemedicine only caused an approximately 40% decrease in-office visits.

To understand the effect of the technology shift on both physicians and patients, here are some of the trends observed in the use of telehealth technologies during the Covid-19 epidemic.

Increased Scenarios for the Use of Telemedicine

There is an increased scenario where providers and patients can use telemedicine remotely to adhere to social distancing rules. Virtual visits have been used during the pandemic to address non-urgent and routine care services of psychiatric or medical conditions. There are also app-based and online questionnaires for screening patients to determine their need for in person services like a physical examination.

Most hospitals have advised patients with Coronavirus disease symptoms or exposure to the virus to first use telemedicine services before showing up at emergency rooms or urgent care centers. This resonates with CDC guidelines that encourage patients with mild Covid-19 symptoms to call their healthcare providers before opting for in person visits and care.

The move to telemedicine to assess Covid-19 symptoms saves about $32 billion lost by Medicare annually in unnecessary emergency department visits. It also reduces the chances of patients spreading the virus or exposing themselves to the virus on their way to the hospital. Furthermore, it reduces the patient numbers in hospital waiting rooms.

Waived Potential Penalties for Violating HIPAA Laws

Telehealth platforms are generally expected to comply with HIPAA {Health Insurance Portability and Accountability Act} regulations on health information and patient privacy. The U.S HHS {Health and Human Services} department announced on March 17, 2020, a waiver for the potential penalties associated with HIPAA violations for healthcare workers serving patients in good faith using everyday communication platforms.

This means healthcare providers can now serve clients on Skype, FaceTime, Google Hangouts, and Facebook Messenger even when these apps do not fully comply with HIPAA regulations. However, you cannot use public-facing [platforms like TikTok, Twitch, and Facebook Live for telehealth services.

The primary concern of providing telehealth services on these platforms is the risk of PHI {protected health information} being shared, sold, or accessed here. To minimize this risk, the NCTRC {National Consortium of Telehealth Services} recommends signing a BAA {Business Associate Agreement} with a platform to ensure that the data exchanged is safeguarded.

Other than HIPAA regulations, most states have laws on the protection of patient information. Check your state guidelines on these privacy guidelines to see if anything has changed in light of the Covid-19 outbreak.

A Waiver on Some Medicare Coverage Restrictions

There is a new waiver authority that is a part of the Coronavirus Preparedness and Response Supplemental Appropriations Act. The CARES Act further adjusted this waiver. The waiver by the HHS secretary concerns some restrictions applying to Medicare coverage for telehealth services advanced to beneficiaries of the FFS {fee-for-service} during the public health emergency initiated by the Covid-19 crisis. Here are some aspects that apply to this waiver:

• lt lifts a requirement that the beneficiaries of telehealth services should live in rural areas. This means patients can access telemedicine irrespective of their geographic location.
• The patient’s home now qualifies as an originating site. This means people can now access a wider range of telehealth services from their homes.
• It allows the access of medical and health care services via telehealth on smartphones with real-time video and audio, interactive capabilities.
• The requirement that a telemedicine provider must have treated the patient in the past three years to qualify for Medicare has been waived. This means that health workers can provide their services to both established and new patients.
• Rural health centers and those that are federally qualified have been allowed by a special provision in the CARES Act to become distant site providers. Medicare beneficiaries can thus access telehealth services from these sites during the Covid-19 outbreak.
• Patients can now benefit from remote patient monitoring services for chronic conditions and Covid-19 by clinicians. For instance, a doctor can now monitor his/her patient’s oxygen saturation levels using remote pulse oximetry.

Here is a figure outlining the primary changes to the Medicare Fee-for-Service restrictions during the coronavirus outbreak. The changes above have increased virtual visits and thus reduced the appointments cancellations and no-shows that cost the healthcare sector billions of dollars annually.

Expansion of CMS Services

In light of the Covid-19 pandemic, the CMS has expanded the range of services that patients can access using audio-only devices. In an interim final rule on March 2020, the CMS stated that healthcare providers were now allowed to evaluate beneficiaries who only had audio phones. Over time, the CMS expanded the allowed services to include patient education and behavioral health services. However, other telehealth services handled by two-way audio-video telemedicine encounters are not covered by the provision.

Another modification by the CMS in the availability of telehealth services because of the Covid-19 epidemic is the inclusion of both hospice providers and home health agencies to handle some services. Some face-to-face visits between home dialysis or hospice patients and healthcare providers have also been moved to telehealth platforms.

Furthermore, there is a temporary waiver in the licensing requirement for telehealthcare providers in their states when they want to extend their services across state lines. Even so, this exemption might not apply to your state’s licensing requirements.

Most important in the expansion of CMS services during the Covid-19 period is that the telehealth services offered under Medicare are not restricted to the management of Covid-19. You can use these expanded services for mental health counseling, preventive health screenings and regular office visits, among other healthcare services.

Medicare still covers all telehealth services included in Part B, so patients are still subject to the 20% coinsurance and $198 if they use these benefits. However, providers can waive or reduce the cost-sharing for telehealth services during the pandemic period.

One of the most crucial service expansions in the Covid-19 outbreak is that patients on Medicare can easily access respiratory devices like multi-function ventilators, non-invasive ventilators, and CPAP machines. Medicare now covers the costs associated with using these devices to manage conditions determined by clinicians.

Lastly, CMS will cover the costs of more than eighty additional healthcare services when these are offered via telehealth. Some of these services include initial nursing facility, discharge visits, home visits and emergency department visits. However, these must be handled by a clinician allowed to provide telehealth services for them to qualify.

Putting Patients over Paperwork

During the Covid-19 emergency period, CMS has temporarily eliminated the paperwork requirement to allow clinicians to get more time treating rather than clerking patients. Written policies on the visitation of patients in Covid-19 isolation and processes are no longer a must for hospitals. These changes are meant to encourage clinicians to focus more on their patients than filling the relevant paperwork associated with different services.

Waived Written Consent

In about thirty-eight states, providers in the healthcare system should obtain and document a patient’s informed consent before engaging in a telehealth consultation. In a few states, this requirement only covers Medicaid beneficiaries, while in others, it applies to all patients irrespective of their payor.

Most states allow verbal consent for telehealth services, but some need written consent. In the era of the Covid-19 crisis, in some states that require written consent, this has been waived. For instance, in Georgia, Maine, Delaware, and Alabama, telehealth service providers can now use verbal rather than written consents.

Voluntary Telehealth Changes by Commercial Insurers

Private insurers can independently decide which telehealth services they will pay for when these are not state-mandated. This means that the telehealth benefits during the Covid-19 pandemic differ among insurers. Most of the major commercial insurers have expanded their telehealth coverage for their fully insured clients, while others have temporarily eliminated or reduced cost-sharing for telemedicine.

In some insurance plans, the waivers and coverage changes only apply to telehealth visits associated with the Covid-19 emergency, but for others, all health indications are covered. Some commercial insurers now allow more services via telehealth. They have also expanded the covered telehealth modalities to include phones and increased patient locations for telehealth.

From the above trends, you appreciate the significant changes in telehealth that the Covid-19 outbreak has brought about. 

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Some healthcare providers are worried about losing some of their revenue by offering telehealth services and are thus reluctant to invest in the platform.

NCDS: The Premiere Option for Healthcare Providers

You need a medical billing solutions company like NCDS to streamline all your revenue streams when offering telehealth services to ease your financial management. Our proven solutions will also improve your cash flow by negating all weak spots through which you might lose revenue; this will enable you to spend time on enhancing the quality of care for your practice. With NCDS, you can reap the benefits of telehealth stemming from the above trends while maximizing your income from this transformative technology. Feel free to visit our website for more information or send an email to sales@ncdsinc.com.

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